Starting January 1, 2022, implementation of some provisions of the federal No Surprises Act will go into effect. The No Surprises Act includes several provisions that impact Pennie customers including:
- Protecting customers from balance billing stemming from surprise medical bills, and
- Requiring customers receive information about compensation paid to insurance brokers and agents for the sale of health insurance coverage or short-term, limited-duration insurance (STLDI).
On September 10, 2021, federal agencies issued a proposed rule to implement some components of the No Surprises Act. The Pennsylvania Insurance Department website contains all information relevant to the No Surprises Act, but below are some frequently asked questions regarding the No Surprises Act and the changes implemented in this proposed rule. Should you have further questions, your insurance provider may have more information. Select your insurance provider below to be directed to the information they provide:
- Capital Blue Cross
What is the No Surprises Act?
The No Surprises Act is a federal law that establishes new protections against surprise medical bills. Surprise medical bills arise when insured customers inadvertently receive care from out-of-network hospitals, doctors, or other providers they did not choose. An example of a scenario that could result in a surprise medical bill would be when a customer seeks emergency care at an in-network hospital but is provided care by a provider, such as an emergency room physician or anesthesiologist, who is out-of-network. The customer sought care at an in-network facility but since they couldn’t choose their provider, they might be subject to a surprise medical bill reflecting the cost of the out-of-network specialist. With implementation of the No Surprises Act, the customer is better protected from potentially high out-of-network charges from those providers.
Surprise medical bills can pose significant financial burdens on consumers when health plans deny out-of-network claims or apply higher out-of-network cost sharing; consumers also face “balance billing” from out-of-network providers that have not contracted to accept discounted payment rates from the health plan that in-network providers accept.
More information can be found at the website for the United States Centers for Medicare & Medicaid Services.
How does the No Surprises Act protect consumers from surprise medical bills?
The Act ensures that customers won’t be charged more than the in-network cost sharing for inadvertently receiving care from an out-of-network provider they didn’t choose. It does this in two ways: First, the No Surprises Act requires private health plans to cover these out-of-network claims and apply in-network cost sharing. The law applies to both job-based and non-group plans. Second, the No Surprises Act prohibits doctors, hospitals, and other covered providers from billing patients more than the in-network cost sharing amount for surprise medical bills.
When do the disclosure requirements of the proposed rule go into place?
These requirements went into place on December 27, 2021, and they would apply to any contract between an insurer and agent or broker that is executed on or after that date.
What information must be disclosed under the No Surprises Act?
Insurance carriers that offer health insurance coverage must now disclose the direct or indirect compensation they provide to agents or brokers to incentivize enrollment in their products. Direct compensation would include monetary amounts (including sales and base commissions) paid by the insurer to an agent or broker for the sale, placement, or renewal of individual health insurance coverage or STLDI. In contrast, indirect compensation includes payments other than sales or base commissions that are paid by the insurer to an agent, broker, or other person that is indirectly linked to the sale of the policy or contract. This may include service fees, consulting fees, awards, prizes, and other non-monetary forms of compensation.
How does the No Surprises Act protect consumers by ensuring they are informed about compensation to health insurance agents and brokers for the sale of health plans?
Additionally, under the proposed rule, disclosure requirements related to health insurance broker/agent commission schedules also go into effect.
When must information must be disclosed under the No Surprises Act?
This information must be disclosed before plan selection and on any documentation confirming your enrollment into health insurance coverage. Under the proposed rule, insurers would be required to disclose compensation information to all potential or new policyholders as well as upon renewal of a policy.
Where can I learn more about the commissions earned by the broker/agent with whom I worked?
For more information, visit the website of your insurance carrier, listed above.